Thursday, 18 March 2010

I'm afraid we need to talk

The King’s Fund has just published ‘Securing Good Care for More People’, its update to the 2006 ‘Wanless’ review - taking the opportunity at the same time to comment on the options described in the UK government’s 2009 Green Paper on the future funding of care for older people. Between the politically unpalatable options of keeping the status quo and introducing free personal care to all, there lies the minefield of determining who should pay what in a reformed system, and thereby deciding who will be the ‘winners’ and who the ‘losers’? The King’s Fund Partnership Model proposed here, a more modest version of that suggested in 2006, would see everyone entitled to 50% of their eligible care costs. The remaining 50% would be met by the individual or their family, but with some matched funding from the state – £1 for every £2 spent is suggested here. Or else the need would be unmet, with all that that implies.

Our survey on this issue (Price of Old Age) shows that while most people want to accept joint responsibility between individuals and the state, there is little consensus on the details of how the responsibility should be divided. This is hardly surprising given a general lack of knowledge about the real costs of long-term care, the uncertainties caused by the current economic crisis, the weight of debt felt by many younger people, and the pressures on providers of care. In the run-up to an election, serious and measured political discussion of this very serious issue is being lost, and I’ll be very surprised if the King’s Fund proposal is greeted with cross-party approval, let alone implemented. Agreement in the House of Commons about a timetable to introduce free personal care for ‘the most vulnerable’ has already failed several times to get through the Lords because of concerns about how local authorities can actually meet the costs.

The all-party commission on 2020 public services led by Sir Andrew Foster, former CE of the Audit Commission, gave a stark warning this week that the real debate about rising costs has not yet really started, and that the British public is unprepared for what must be major changes; ‘If citizens refuse to pay more, they have to contribute more’. This implies, of course, that if families or communities don’t or can’t provide care themselves, then individuals’ needs may not be met at all. The King’s Fund report, aside from suggesting their costing model, also makes some good points about the reform of delivery as not a once-and–for-all event, but as a measured, staged process, taking on board the bigger picture: a process that will take many years, transcend the lifetime of any parliament, and require proper political consensus to achieve fairness within and between generations. As a country we are already coming very late to this, so let’s not drop the ball now.